One physician’s burnout and unconventional rise from the ashes

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Finding Balance

After taking a thoughtful break from posting (aka being busy and not writing), I find myself today with an unexpected afternoon off, and thought it would be a great time to reconnect with my blog. Let me start with apologies to a few of you who took the time to get in touch me with me – to say I was “delayed” in getting back to you would be the understatement of the year. #epicfail. Hopefully I’ve caught up with everyone at this point.

I find it interesting that I chose to blog today on balance, because I have quite a few “real” tasks staring at me from by inbox with rapidly approaching deadlines. But I think this illustrates the point of balance precisely, at least in my own experience. Sometimes achieving balance is committing to things that bring you joy and pleasure outside your job as intently as you commit to work, and knowing when you have the leeway to do so.

In my previous career position as an academic physician, I burned out rather dramatically after only 6 years in an attending-level position. I’ve now hit the 4 year mark at my current job, and continue to look forward to going into work, taking on new challenges, and investing effort into expanding my program (including training a new advanced practice provider who is SPECTACULAR to work exclusively with me – props to my department chair for hiring her without batting an eyelash when I asked if it was possible). One of the critical characteristics that I think separates these two experiences is balance. More specifically, self-defined balance.

In my previous job, I spent a lot of time doing either what other people told me I should be doing, or doing things because I thought I should be doing them out of guilt, obligation, resume building, etc. Don’t get me wrong – as a newly-minted attending fresh out of residency, a huge part of my job was to say “YES!!’ to work that came my way.

I’m quite convinced that one of the big contributing factors to me burning out was my lack of balance over time. And when I really look at how that played out, it was really subtle and quite tricky. Make no mistake, I am BUSY AS F**K in my current job, and I say yes to plenty of things that come my way. But how I spend my time is much better tailored to my own preferences.

The nice thing about trying to pick this apart is that at my old job, I was 60% FTE, and that’s exactly what I maintain at my current job (despite intermittent check ins from my chair to see if I maybe want to bump up my time a little…. thank you, but the answer is still no.) But my balance now is so much more appropriate for me, and the changes may appear small, but have huge consequences.

Where I used to work (which I will henceforth refer to as “Mordor”), I did all sorts of work outside my contracted hours, which seems to be pretty much true for most physicians in the US. I took overnight call for the clinic a couple of times a month (meh), covered the nursery one week every few months (gross due to the early hours), and took a Friday through Monday call weekend once every eight weeks, which was a F**KING SLEEPLESS HORROR SHOW that was exacerbated by the fact that we had absolutely zero nursing triage, because god forbid that would have COST MONEY. This functionally translated into EVERY SINGLE CALL from a parent coming through directly to the on-call pager, including the father who called me at 3 am to let me know that HE HAD RUN OUT OF BABY FORMULA.

Needless to say, this was not a great sustainable model for happy employees.

At my current place of employment (which I affectionately refer to as CandyLand), I am also asked to engage in activities that are outside my contracted hours. These include things like developing a lecture series for the department on use of culturally-inclusive language (winning), create a core curriculum in my area of expertise for our residents (also winning), and chairing a community resource multidisciplinary committee dedicated to improving developmental outcomes in early childhood (winningest win!). I invest quite bit of time and energy into activities like this, but I never feel taken advantage of being asked to do them, mainly because they are things I naturally enjoy. If you look closely, you will also notice that none of these activities involve taking overnight call, which for me is a personal Dante’s inferno. Some people really are not too phased by being on call, but I have discovered that I would pretty much rather suck on hot lead than take call. I even made a personal investment in not taking call by purposefully leaving money on the table when I initially negotiated my contract, stipulating that I wouldn’t be taking call. And my department was fine with it. #balance

When I was working in Mordor as a 60% employee, I had most mornings to myself. Which sounds awesome on paper. But because the 60% (plus all the extra bullshit overnight call that turned me into a walking zombie) was so draining and I was so unsupported in my role, I didn’t have a lot left to put into the other 40% of my week. Even things I liked were a chore, because I didn’t have much energy for them. Working out was a necessary evil (and I’m a person who LOVES to work out). Learning a valuable skill, like cooking, was out of the question, and my husband’s and my diet suffered for it. By the time I left, I was on medicine for reflux and high cholesterol, and was a borderline diabetic.

Now working in CandyLand, my 60/40 split looks much different. As fiercely committed to my career, my department, and my patients as I am, I am equally as committed to my own health. My time away from work, for the most part, remains my time. Through a series of random events, Crossfit found its way into my life (don’t get me started – that’s an entirely separate blog post). Now four mornings a week Monday through Friday, rain or shine, I am at the Crossfit box, and absolutely adore it. And I treat it pretty much as a scheduled standing meeting between me and my health. I don’t use it as “swing space” to hold extra clinics, meetings, projects, etc. I also learned how to cook, and make a healthy home-cooked dinner at least four times a week. My reflux is gone, my glucose is under control, and I have the cholesterol profile of a 16 year old. #balance

The bottom line is that it took me years to recognize how much the part of my life I’m at work affects the rest of the time I am not, and that I am pretty much the only person who has real power to do anything about it. It’s kind of like having a really good bed – the 30% of your life you spend in it plays heavily into the 70% of your life that you aren’t.